热毒清对肝衰竭肠源性内毒素血症的影响

Effect of Reduqing to intestinal endotoxemia in hepatic failure

[目的]探讨"体外血液净化"联合"体内血液净化"制剂"热毒清"在治疗肝衰竭肠源性内毒素血症当中的疗效。[方法]将50例肝衰竭患者分为单独应用"体外血液净化"(Ⅰ组)、"体外血液净化"前已应用"热毒清"(Ⅱ组)以及"体外血液净化"期间加用"热毒清"(Ⅲ组),观察治疗前后血浆内毒素(ET)水平、过氧化脂质(LPO)、肿瘤坏死因子α(TNF-α)、总胆红素(TBIL)及病死率。[结果]肝衰竭患者内毒素血症发生率为100%,肝衰竭3组患者治疗后ET、LPO和TBIL水平均较治疗前明显下降,Ⅱ组TNF-α与治疗前比较有明显下降,治疗后Ⅱ组ET、LPO和TNF-α较Ⅰ、Ⅲ组患者下降明显。虽然Ⅱ组TBIL治疗后均值最低,但与其他两组比较差异无统计学意义(P>0.05)。Ⅰ、Ⅲ组患者的最终病死率为75%、68.75%,Ⅱ组患者病死率为44.44%,虽然与Ⅰ、Ⅲ组患者病死率比较明显下降,但差异无统计学意义(P>0.05)。[结论]肝衰竭组患者有不同程度的内毒素血症。"体内外血液净化"疗法,无论单用还是联合应用,对改善患者内毒素血症、减轻患者肝细胞炎症损伤均有明显作用,"热毒清"早期应用联合"体外血液净化"有助于更好地降低ET,减轻由其诱导的LPO和TNF-α释放,能更好地改善肝功能,且早期应用对降低病死率有积极意义。

[Objective] To investigate the efficacy of “extracorporeal blood purification”combining with “blood purification in vivo”chinese drugs pharmaceutics “Reduqing” in the treatment on intestinal endotoxemia of hepatic failure. [Methods] The 50 cases of hepatic failure were distinguished by using a single application of “extracorporeal blood purification” （group I）, the application of“Reduqing”before“extracorporeal blood purification”（groupⅡ） and“Reduqing”added during the treatment of“extracorporeal blood purification”（groupⅢ）. Levels of plasma endotoxin （ET）, lipid peroxide （LPO）, tumor necrosis factorα（TNF-α）, total bilirubin （TBIL） and mortality were observed before and after treatment. [Results] Incidence of endotoxemia in hepatic failure patients was 100%, levels of ET, LPO and TBIL decreased more significantly than before treatment in three groups of liver failure patients, compared with before treatment, TNF-αin groupⅡdecreased significantly after treatment. ET, LPO and TNF-αin groupⅡdecreased significantly than the groupⅠ, groupⅢ. Although the general average of TBIL in groupⅡwas the lowest, the difference between two other groups was not statistically significant （P〉0.05）. Mortality in groupⅠandⅢwere 75%and 68.75% respectively, and in groupⅡwas 44.44%. Although the mortality in groupⅠand Ⅲ decreased, differences were not statistically significant （P〉0.05）. [Conclusion] There were different degrees of endotoxemia in patents in liver failure group.“In vivo and extracorporeal blood purification”therapy, whether used alone or in combination, plays a significant role in improving ETM and reduce the inflammatory in hepatic cells. “Reduqing” combining with“extracorporeal blood purification”used in early stage is contributed to a lower ET, reducing LPO and TNF-α. It can also improve liver function, and has a positive significance on reducing mortality by using in early stage.